Rhinoplasty, Genioplasty (chin impant), submental liposuction

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This women wanted a rhinoplasty and a facelift. I agreed with the rhinoplasty. However, after a discussion in became apparent that want she wanted from the facelift was less jowls, more definition to the mandible boarder, and a more distinct neck and submental region. I am not against doing facelifts in patients who are forty years old when the indications are strong. In this patients case I felt a chin implant and neck liposuction would be a more direct way to get her desired results. I should mention that years back she had an a reduction BSSO and I think while this corrected her class III occlusion he put her chin out of balance (made it too small and telescoped the soft tissues backward thus accentuating a double chin and the jowls - that is a bit academic, but it is what makes some of this stuff so interesting and satisfying).